Self-Care vs. Healthcare? Hospital Dining – Food for Thought

Have your attempts to be healthy become a tug of war that feels like self-care vs. healthcare?

In theory, self-care goes hand in hand with healthcare. How often are we told that eating well, exercising enough, and getting enough sleep contribute to disease prevention? In fact, preventive care has dominated healthcare rhetoric in the US since Health Maintenance Organizations (HMOs) gained traction in the 1980s. It seems logical that healthcare and self-care would have become increasingly in sync since that time. If eating well, exercising enough, and getting enough sleep can help prevent and heal disease, why isn’t there more emphasis and support for those when I see my physician or visit the hospital?
health
It is true that from 1985 until now, recommendations have increased for screenings to detect breast cancer, prostate cancer, colon cancer, cholesterol levels, diabetes, and STDs. Most insurance covers such screenings as well as well-baby checkups and physicals. But something is amiss.

During the same time frame, the percentage of the population with diabetes has increased from 5.53 to 23.35. Deaths from heart disease began to show subtle signs of increasing in the 1980s after 20 years of decline. (Rates have not decreased since 2011 and actually increased in 2016.) The number of people with asthma has increased in the US from approximately 6.8 million people in 1980 to 24.6 million. Some studies show that autoimmune disorders like celiac disease, type 1 diabetes, rheumatoid arthritis, systemic lupus erythematosus, and inflammatory bowel disease have also risen dramatically.

Not only that, prescriptions for medication have increased. According to the Centers for Disease Control, in 2015, approximately 269 million antibiotic prescriptions were dispensed from outpatient pharmacies in the United States. That is enough for five out of every six people to have received one antibiotic prescription that year. The CDC estimates that 30% of those prescriptions were unnecessary.

Since 2005, opioids have been prescribed for pain at a rate as high as 80 per 100 people and as low as 66.5 per 100 people across the US. In my particular state, opioids were prescribed at a rate of 114.6 prescriptions per 100 people in 2017. Yes, that’s more prescriptions than residents (of any age) in the state. Since I’m pretty sure most infants and small children weren’t receiving them, quite a few people must have been doubling up.

ADHD diagnoses and resulting prescriptions reached as high as an average of 11% of children across the US in 2012, then settled at a rate of about 9.4%. My state well exceeds the national average in this area. We diagnosed as many as 14% of children as having ADHD in recent years while Nevada was finding only 4% of children had the condition.

We also medicate for “pre” conditions like pre-diabetes, pre-stroke, pre-cardiovascular disease, and pre-breast cancer. The medications for these preconditions are not vaccines that prevent disease. They are meds that may reduce the risk of disease progression. They’re actually reducing disease progression that may not occur even without the medication.

In contrast, the new patient questionnaire when I changed primary care physicians last year only asked about medical conditions (celiac disease was not included). It did not explore my nutritional, exercise, or sleep habits nor did the nurse or doctor inquire. When I visited my county health department last month for a tetanus booster, there was no attempt to collect data regarding these habits.
salad
But the starkest contrast I’ve experienced between healthcare rhetoric regarding self-care and actual experience with the healthcare system in recent months has been in hospital dining services. With the birth and subsequent 60-day hospitalization of my granddaughter, I’ve had the opportunity to experience dining at multiple hospitals in my city. One offered room service style dining for patients and another will offer it soon. The pediatric hospital did not deliver meals for parents, but included a cafeteria meal each day in the price of the room.

While I have many concerns regarding hospital dining, one could easily be addressed — information. Noting each food on the menu, in a steam table, or on a shelf that contains one of the 8 most common allergens would be a great start. In Ireland, 14 allergens and their derivatives must be noted on all restaurant menus, prepackaged food, food purchased online, food from supermarkets, delicatessens, bakeries, and farmers’ markets. Having that information automatically available is customer friendly and will save the staff time.

This small beginning could eventually be expanded to a full listing of ingredients, nutritional summary, and calorie counts for all menu items. Room service menus contain a limited number of items making it entirely possible to research this without undue burden. Hopefully, someone is reviewing this information prior to choosing a food for menu inclusion, but I won’t make that assumption. If that’s the case, it’s just a matter of importing data as the menu is developed then passing that data to the graphic designer. Easy peasy.

A focus on offering a wider variety of fresh food prepared in-house instead of packaged and processed food would signal that good nutrition is truly valued as a foundation of good health. Having a salad bar is great, but it would be refreshing to see a Buddha Bowl filled with greens and other assorted fresh vegetables, quinoa, brown rice, chickpeas, and baked sweet potato chunks drizzled with lemon, garlic and tahini sauce or tacos (or rice bowls) filled with sautéed baby portobello, shiitake, and oyster mushrooms, red and green bell peppers, onions, and goat cheese or gazpacho full of fresh tomatoes and other vegetables served alongside a turkey and avocado sandwich.
garden
Fresh vegetables may be more costly, but they also offer an opportunity for a Patient and Family Centered Care educational experience. Imagine how intimidating it is as a patient to constantly receive admonitions to change your diet if you don’t know kale from spinach from chard or have never eaten a Brussels sprout. If you really don’t know what foods to choose in the store, can’t afford to waste money on food you may not like, and have never prepared fresh food, these admonitions may be lost on you.
If some produce was grown on site in containers, rooftop gardens, or in courtyards, it could be used to teach patients and families about better nutrition and healthy food preparation. Onsite gardens can be incorporated into occupational therapy as well. Is that as easy as clicking a box to order prepackaged food? Of course not, but that doesn’t mean the idea should be summarily dismissed.

But the hospital menus I’ve seen are far, far, far from fresh food. I can’t think of a single reason that Fruit Loops should ever be included on a hospital menu and yet, last week as I perused one there they were listed under breakfast. The number one ingredient in Fruit Loops is sugar. SUGAR!?! Don’t we call those empty calories?

It’s hard to accept eating advice from a healthcare system that presents Fruit Loops as an option. For me, it’s mind-boggling. We are preaching to people to lose weight and not feed their kids added sugar while the hospital that treats their diabetes offers sugary cereal for breakfast. At best, it’s hard to take seriously nutritional information that is dispensed from such a hospital. Maybe that’s why some patients ignore the healthy eating information they receive.

Before we leave the subject of sugar…How about stocking the hospital deli yogurt station with plain yogurt and fresh fruit? If a patient thinks they have to have sugar with their yogurt, make them add it. Having to use extra effort just might get their attention. Don’t offer sweet tea. Again, having to add sugar is a chance to think about the fact that sweet tea is filled with added sugar. Not offering sweet tea shows no tacit approval that might be confusing to patients. Don’t offer soft drinks through room service. If a patient wants one, someone will have to take a walk to a vending machine or dining facility (Ah, we just added exercise for someone). Tiny disruptors may create some grumbling and discomfort, but they also interrupt habits and that can be a great opening for change.

steam trayI’d prefer larger changes in hospital dining options, but I’m realistic enough to recognize that even small changes can face huge obstacles. That must be true or surely we’d be doing a better job of reconciling the disconnect between healthcare rhetoric regarding diet and the food offered to those using the healthcare system. Surely we can see that we’re making self-care unnecessarily difficult in healthcare dining.

I’ll leave you with a quick story. When I was dating a physician who directs a department at the local medical school, he had a colleague with heart disease. That colleague, also an MD, had a heart attack and was hospitalized in the facility where they both practiced. The doctor’s wife noticed that every meal he received as a patient was loaded with bacon, gravy, another heavy or sugary sauce, or red meat. After a couple of days, she asked if they could bring him something different. Knowing his affiliation with the hospital, dining services was willing to accommodate. They asked what she wanted them to bring. She said, “I don’t know, maybe some fish?”. The next day, lunch arrived with some fish…a can of tuna dumped in the middle of a plate unadorned and unaccompanied.

And that, my friend, tells you a lot about the disconnect patients experience between self-care and healthcare.

https://www.ncbi.nlm.nih.gov/pubmed/9553445

https://www.cdc.gov/diabetes/statistics/slides/long_term_trends.pdf

https://www.cnbc.com/2016/12/22/as-heart-disease-deaths-rise-health-experts-focus-on-prevention.html

https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=2831365_dem-45-0387f1.jpg

https://www.fightchronicdisease.org/sites/default/files/docs/GrowingCrisisofChronicDiseaseintheUSfactsheet_81009.pdf

https://www.cdc.gov/mmwr/preview/mmwrhtml/00052262.htm

https://www.epa.gov/sites/production/files/2018-05/documents/asthma_fact_sheet_0.pdf

https://multiplesclerosisnewstoday.com/2016/01/08/rise-ms-autoimmune-disease-linked-processed-foods/

https://www.ibhri.org/blog/2018/3/5/are-autoimmune-diseases-on-the-rise

https://www.niaid.nih.gov/diseases-conditions/autoimmune-diseases

https://www.aarda.org/news-information/statistics/

https://www.cdc.gov/antibiotic-use/stewardship-report/outpatient.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3010093/

https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html

https://www.cdc.gov/ncbddd/adhd/data.html

https://www.ncbi.nlm.nih.gov/pubmed/27549416

https://www.usatoday.com/story/news/nation-now/2018/06/28/cdc-report-only-23-americans-get-enough-exercise/741433002/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4605258/

https://www.fsai.ie/legislation/food_legislation/food_information_fic/allergens.html#14_allergens

http://www.cooking2thrive.com/blog/get-know-breakfast-kids/

http://www.cooking2thrive.com/blog/get-know-breakfast-sandwich/

http://www.cooking2thrive.com/blog/get-know-breakfast-foods/

http://www.cooking2thrive.com/blog/get-know-food/

Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”

You May Need a Nap

If you’re eating well and exercising, but everything feels like a bigger deal than usual, you may need a nap. You may need more than a single nap. You may need more sleep on a regular basis. If you’re under a significant amount of ongoing stress, you may need a good night’s sleep, a nap, and additional down time.
nap
My father-in-law swore by the 20-minute power nap. One of only 3 physicians in a town of 7000, he worked long hours. Every day at lunch, he’d come home to eat and then sleep in his recliner for 20 minutes. He didn’t set an alarm. He just woke up ready to go back to the clinic. He seemed to take the long hours in stride, so I guess naps worked for him.

Each of us has individual sleep needs. A regular 20-minute power nap may work for some while others need a full 8 hours each and every night. Others may function well on 6 or 7 hours during the week supplemented by 10 to 12 on the weekend. Because the particular rhythm is individual, it can be difficult to determine when a lack of sleep first begins to cause problems.

Like many conditions, the effects of sleep deprivation compound slowly over time tricking us into thinking we’re experiencing something normal rather than problematic. Failing to recognize and correct the problem slowly erodes emotional resiliency, the immune system, and our overall health. Early signs could be that you notice feeling more than tired or irritable. Perhaps you feel foggy, forgetful, or have minor hallucinations. Perhaps you feel more anxious than usual or seem to lack the joy that you previously felt. Any of these can be indicators that you are not getting enough rest.

We all have long to-do lists and such an expectation of immediacy that it can be tempting to ignore our bodies’ signals until we reach the point of exhaustion or other health concerns. Obviously, it is better to recognize the signs early and remedy the problem before it affects our immune systems or leads to a chronic condition like diabetes, high blood pressure, or heart disease.

Making the time to slow down is a constant challenge. Meditation and yoga can help, but where can you find time to work them in? And the more pressure you put on yourself, the harder it is to let your mind rest.
big deal
If this were easy, we’d all get enough rest, but according to the CDC almost a third of us are sleep deprived (defined as less than 7 hours per 24-hour period). This is especially true in the eastern and southeastern United States. In my particular state, the lowest rates of sleep seem to fall in the poorest counties.

Most of us think that we can catch up by sleeping late on a Saturday morning here and there. If we still feel exhausted, we assume there must be a different problem. This can mean we continue to exhaust ourselves.

It can take weeks to fully recover from sleep deprivation. Adding an hour or two per night over a longer period of time will give you the most benefit and if you can sustain the extra hours, prevent the problem from recurring.

That doesn’t mean there aren’t times you just need to shut things down. If you have reached a point at which you cannot function well, it is time to take more drastic action. Pretend you have a 24 or 48-hour virus. Go to bed and don’t do anything you would put aside if you really had that virus. Giving yourself permission to do this will help quiet your mind and put it in sync with your intention of resting.

Temperature, bed quality, light, and noise can all affect sleep quality. I learned long before smartphones existed that a digital clock with a red display disturbed my sleep. I had to go back to a clock with a face with hands. Now I move the laptop out of the room because the pulsing sleep indicator is disruptive.

Alcohol will give the illusion that it helps you sleep because you may fall asleep more easily, but it can interfere with REM sleep resulting in daytime sleepiness and performance impairment. I’ve heard plenty of self-diagnosed insomniacs complain about their lack of sleep while touting alcohol use as the solution to the problem. They don’t seem to realize that they’re still complaining about insomnia. If alcohol were fixing the problem, wouldn’t that complaint be gone?

I fall asleep easily and usually sleep well, but during times of extreme stress, I require additional hours of rest. I can’t get by with 6 or 7 hours for two nights followed by 8 for two nights. I need a full 8 – 9 hours each night and maybe a nap or two on the weekend. I don’t know whether my need is more physical, mental, or emotional, but I know it’s important to shift all systems into neutral in order to feel restored.

The irony is that I most need more rest when I least feel I can afford the time. Nonetheless, I am learning to tell myself the minute I feel I have to push myself, “You may need a nap!” 

https://www.livescience.com/52592-spooky-effects-sleep-deprivation.html

https://www.nhs.uk/live-well/sleep-and-tiredness/why-lack-of-sleep-is-bad-for-your-health/

https://www.cdc.gov/sleep/data_statistics.html

https://hbr.org/2006/10/sleep-deficit-the-performance-killer

https://pubs.niaaa.nih.gov/publications/arh25-2/101-109.htm

http://www.cooking2thrive.com/blog/wrap-it-up/

Get to Know Some Other Breakfast Foods

Last week we learned about cereal, now let’s get to know some other breakfast foods. More than 80% of us eat breakfast at home. If you’re like me, you eat it in pjs with a cup of hot coffee in hand. There’s no end to the possible breakfast options, so we’ll take a look at some of the more popular items we choose at home.
eggs
Eggs
Eggs are king of the traditional American breakfast. Simple to cook in a variety of ways in only a few minutes, an egg is packed with protein and low in carbohydrates. One egg has 70 calories, 6 grams of protein, 1 gram of carbohydrate, and 65 mg of sodium. The high protein and low carb content make eggs an ideal choice for diabetics.

Unlike most foods, eggs contain all 9 essential amino acids that cannot be made by your body plus iron, vitamins A,D,E, & B12, folate, selenium, lutein, zeaxanthin, and choline. Eggs also provide the primary source of cholesterol in the American diet. One egg has 195 mg.

Because blood cholesterol has been of concern in heart disease, for many years Dietary Guidelines recommended limiting consumption of cholesterol thereby giving eggs a bad rap. This changed in 2015. The Guideline regarding cholesterol was removed because it is now recognized that dietary cholesterol plays no role in blood cholesterol.

With that concern removed, it’s hard to find a better food to get you going in the morning.*

Ever drink a glass of orange juice with your eggs?
Apparently a lot of us do. About two billion dollars worth of orange juice are purchased in the US each year. The largest selling brand is Tropicana Pure Premium.

Orange Juice

An 8 oz glass of Tropicana Pure Premium No Pulp Orange Juice has 110 calories, 2 grams of protein, 0 fat, 0 sodium, 450 mg of potassium, 22 grams of naturally occurring sugars and a total of 26 grams of carbs. A glass of this juice also provides 120%** of the recommended daily allowance of vitamin C, 2% of the daily value for calcium, 10% for thiamine, 4% for riboflavin & niacin, 6% vitamin B6, 15% folate, and 6% magnesium.

oranges
How does that compare with an orange?

Orange

One large orange has about 86 calories, 2 grams of protein, 0 fat, 4 grams of dietary fiber, 17 grams of sugars and 22 total grams of carbs. It also has 163% of the RDA of vitamin C plus naturally occurring calcium (7% RDA), vitamin A (8%), and iron (1%).

Looks like an orange has less calories, more fiber, more calcium, more vitamin A, more iron and 43% more vitamin C, but lacks the added thiamine, riboflavin, niacin, vitamin B6, folate, and magnesium.

If you are choosing orange juice for vitamin C, you’ll get significantly more from eating an orange plus the benefit of 4 grams of dietary fiber and 5% more calcium.

Before choosing store bought orange juice, you should also be aware that in spite of the “not from concentrate” verbiage on the label, this type of orange juice is processed by having the oxygen removed so it can be stored in vats for up to a year. This process removes the flavor. A flavor pack is then added so that when it’s bottled it will taste like orange juice. Because the flavor pack is made from orange by-products, it is not considered an ingredient, and therefore isn’t required to appear on the label despite the fact that the by-products are chemically altered. 1)

yogurt

What about yogurt for breakfast?

Up until two years ago, Greek yogurt sales were skyrocketing. While the growth has now slowed to a moderate level, you can’t pass a dairy cabinet without seeing a wide array of single serving yogurt options. Many of those convenient cups are occupying our breakfast tables, but not all single serving yogurt is created equal.

The top selling brand of yogurt is Chobani, so let’s start there.

Non-fat Greek Yogurt
Chobani 5.3 oz non-fat Greek yogurt contains 80 calories, 15 grams of protein, 0 fat, 10 mg cholesterol, 55 mg sodium, 4 grams of sugars and a total of 6 carbs, 15% of the RDA of calcium, and 6% of potassium. This yogurt is also full of probiotic live and active cultures that help your digestive tract.

That’s twice as much protein as an egg for only 10 additional calories. Plain Greek yogurt is also low in carbohydrates and has a significant amount of calcium making it another good choice for diabetics.

Plain yogurt? Yuck! What about flavored yogurt?

Blackberry Yogurt
One 5.3 oz container of Chobani Greek Yogurt with Blackberry on the Bottom contains 120 calories, 12 grams of protein, 0 fat, 5 mg cholesterol, 50 mg of sodium, 16 grams of sugars and a total of 18 carbs, 15% of the RDA of calcium, and 6% of potassium. Like plain yogurt, this version is also full of probiotic live and active cultures that help your digestive tract.

While blackberries may account for some of the sugar listed on the label, evaporated cane sugar is the 2nd ingredient, meaning that many of the 16 grams of sugar come from added sugars. The sugar adds most of the 40 additional calories. Although the protein content is still high at 12 grams and the probiotics are present, added sugar makes this yogurt less healthy in general than plain yogurt and doubly bad for diabetics and those with heart disease.

I understand why flavored yogurt is tempting. Yogurt can be a bit tangy on its own. I eat 1/3 – 1/2 cup of plain Greek yogurt for breakfast most mornings. Rather than adding sugar, sweetener or honey, I top it with about a tbsp of golden raisins and 10 raw almonds. As a breakfast, this is crunchy, filling, and just sweet enough. The nuts and raisins both add protein, the nuts add fiber, and the raisins add carbs. This combination is also quick and doesn’t require cooking.

While I find Greek yogurt convenient, many people prefer the portability of breakfast bars. The top selling nutrition/health bar is Clif.

Clif Oatmeal Raisin Walnut Bar

In one Clif Oatmeal Raisin Walnut Bar you’ll find 250 calories, 10 grams of protein, 5 grams of fat, 150 mg sodium, 7% RDA of potassium, 5 grams of dietary fiber & 4 grams of insoluble fiber, 20 grams of sugars and 44 grams of total carbohydrates. It is also fortified with vitamins & minerals.

Although this bar offers a good amount of protein and fiber, the calorie count is high and the total amount of carbohydrates is very high. These bars are not an option for those who are gluten-free, and they cannot be characterized as a good choice for those who are diabetic or at risk for heart disease.

Of course there are other breakfast bars with varying amounts of protein, fat, and sugar so you may find one that fits your eating plan. You won’t find one that beats eggs or plain Greek yogurt in nutrition per calorie.

Of all the foods we’ve learned about so far, eggs and non-fat plain Greek yogurt offer the best high protein, low fat, low carb breakfast choice.

Next up, we’ll look at some popular on-the-go breakfast sandwiches and then we’ll be ready to move on to lunch and dinner.

Should we explore coffee? Probably, but right now I’d rather just have another cup. Until next week…

*Eggs are one of the 7 top allergens. Approximately 2% of children are allergic to eggs, but 70% outgrow the allergy by the time they’re 16. http://acaai.org/allergies/types/food-allergies/types-food-allergy/egg-allergy If you have an egg allergy, please avoid eating eggs and products containing them.
**Percent of daily values listed are based on a 2000 calorie diet. Your DV may be higher or lower based on your calorie needs.
Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”

1)http://www.foodrenegade.com/secret-ingredient-your-orange-juice/
http://www.huffingtonpost.com/2011/07/29/100-percent-orange-juice-artificial_n_913395.html
http://gizmodo.com/5825909/orange-juice-is-artificially-flavored-to-taste-like-oranges

Navigating Medical Care

mazeNavigating medical care can be an exhausting process as any celiac, IBS, Crohn’s, diabetic, or cardiac patient knows. As this year draws to a close, I’m looking forward to the renewal a new year promises.

I spent the past few days with my mom in a rehab facility. She is a dialysis patient and last week had 3 small strokes. On the phone from the ambulance as she was transported to the hospital, she sounded ok, but said her right arm and hand wouldn’t work right. Five days later, she arrived at a facility where she could receive physical therapy multiple times per day. It was Christmas eve.

Of course holiday staffing varies from the norm. On Christmas day, our nurse was in charge of 60 patients. There are 480 minutes in an 8 hour shift. That means, she could spend 8 minutes per patient even if she didn’t take a single break. We used more than 8 minutes of her time when my mom passed out in the wheelchair from low blood pressure. Needless to say, there is no time for the staff to make sure Mom eats or gets enough fluids.

My mom is lucky because at least one of us has been able to be there for a portion of every day. In spite of that, it has been difficult to get enough information together to assess whether a bad day is just a bad day, or the beginning of a downward trend. It’s hard to know whether we need to quit worrying about the food on the cafeteria tray and just get some Power Yogurt down her. We know she’s not getting enough protein to fend off infection for long. Unfortunately, our experience is not unusual.

I learned long ago when I had a rare parasite that caused recurring pneumonia that when you’re weak and in pain, you must have an advocate with you every step of the way or you can quickly be dismissed and become lost in the system. My lawyer boyfriend was with me when I was trying to get a referral to a large diagnostic clinic. He could barely contain his laughter watching me bite my lip when my pulmonologist said, “If you didn’t have an intelligent boyfriend here with you, I’d say this is all in your head.” And he wasn’t the first physician to say that during my two year ordeal.

I was young, healthy, went to the doctor promptly and still almost died with the first pneumonia after having been diagnosed with a bladder infection. I actually had psittacosis from Chlamydia psittaci which had become encapsulated in a recently capped tooth. This experience made me acutely aware that navigating medical care is best played as a team sport.

During that two years, I read all of my medical charts. This was also an eye opening exercise. The history recorded in the charts often wasn’t even remotely related to the history I gave. I realize my symptom group was unusual. Well, actually it wasn’t for someone with psittacosis, but it was unusual enough for one nurse to determine that I was just a bad historian.

At some point, most of us will need the expertise of the medical system. Without it, we do not have the depth of knowledge, necessary labs, sophisticated testing equipment, or access to medication that may be necessary to get us through a crisis and put us on a path to improving health. Is there anything we can do as patients to make sure we have the best chance of getting optimum results from medical care?

While nothing will guarantee a certain health outcome, here are 5 things you can do to facilitate a more positive journey in the healthcare system:

1. Choose a friend or family member you trust to act as your advocate in any major medical event.
The best advocates care about your well-being, can remain calm in a crisis, are good listeners, can process and prioritize information, are unafraid to ask questions, and will tell you the truth in a kind manner.

Be sure to identify your advocate as someone who has your permission to view healthcare information so that your care providers will not worry about a HIPAA violation. http://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html

journal2. Keep a daily journal of your condition.
Try to record facts without interpretation. For example, if you feel your energy level has significantly dropped, record how much sleep you get, when you get it, how many fluids you consume and what kind, what you are eating, how much and when, how much exercise you get, what kind, and when you get it, then note how tired you feel on a scale from 1 – 10.

Doing this every day will help you have a realistic picture of what is happening over time. It will also help identify areas in which a change in routine may help improve your symptoms. If you are too weak to do this, your advocate or caregivers can make notations for you and record their observations as well.

3. Be informed. Ask questions. Make decisions.
You are ultimately in charge of your healthcare. If you do not ask questions, you may be passively agreeing to treatment you would never actively choose. It can be helpful to think of yourself as pilot in command.

In an airplane, the pilot in command (PIC) is the person who makes the final decision about what will happen in an airplane. He can accept or refuse instructions from air traffic control and he is in responsible for all operations of the plane until he actively turns over command to another pilot by saying something like, “your plane or your aircraft”, and hearing “my plane” as a response. He then repeats, “your plane”. This is called a Positive Exchange of Controls.

If air traffic control says, “23 Charlie Tango cleared to land 22 left” it does not mean that the PIC must land the plane. He can request a different runway. If he is not cleared for the requested runway, he can initiate a go-around.

You are the pilot in command of your healthcare. You will receive lots of information from instruments and personnel. The more informed you are, the better the quality of questions you can ask and the better resulting decisions you can make. Your doctor is air traffic control. From his vantage point, he can see traffic and the runway better than you can, but he won’t know that you had a fuel leak and do not have enough glide distance to make the runway without input from you. You have the best odds of a safe landing when you work with your doctor as a team to identify alternative landing areas. Once determined, you decide the destination with which you feel most comfortable. You inform the doctor where you prefer to go from here, then you focus on the procedures that will result in your best chance to safely reach the landing area.

Just as it is common to think that air traffic control actually means the tower is in control, many patients do not recognize that they have the choice to request a plan that fits them. More typically, they defer to whatever initial plan the doctor proposes while they’re in her office and then fail to follow that plan once they get home and it doesn’t fit their lifestyle. This can be detrimental to any long-term progress.

4. Treat everyone kindly beginning with yourself.
When you have a chronic condition rather than a medical emergency, it can slowly eat away at your energy and attitude. A desire for relief may lead to impatience with medical staff. While you may feel justified in taking your frustration out on nurses, techs, or aides, doing so will not encourage them to treat you kindly.

The simplest way to prevent reaching the point at which you lash out is to recruit consistent, adequate social, emotional, psychological, and spiritual support. These needs are very individual, so a high level of self-awareness will be helpful in determining what and how much you need.

Incorporating a regular exercise, meditation, or yoga practice can strengthen your connection to internal resources. You may also find restoration in activities like gardening, cooking, writing, reading, fishing, walking, painting, woodworking, swimming, dancing, volunteering, or playing with your children or grandchildren.

flatbread5. Decrease the need for medical intervention.
You don’t have to worry about navigating the medical system when you’re healthy enough to only require routine check-ups or regular monitoring. In some cases, significant lifestyle changes can minimize the need for medical intervention. The effects of regularly eating a balanced diet of fresh foods, drinking plenty of water, getting adequate sleep and exercise, and filling our lives with passion and laughter should never be underestimated.

The new year is always a great time to wipe the slate clean and do things differently. I hope you’ll find these tips helpful the next time medical care is required.

As we approach the change to 2016, I wish you an abundance of health and hilarity!

Happy New Year!